Sterilisation

Question 1

What are the types of sterilisation procedure

Answer 1

Hysteroscopic: expanding springs inserted into the tubal ostia via hysteroscope → induces tubal fibrosis
Tubal occlusion: laparoscopic procuedre to occlude the fallopian tubes with filshie clips

Question 2

When is hysteroscopic sterilisation indicated

Answer 2

Women with high surgical risk

Question 3

What advice must be given prior to sterilisation

Answer 3

Irreversible
Vasectomy is safer, quicker and associated with less morbidity
The coil has a higher success rate
A high proportion of women regret sterilisation
Does not protect against STIs - would still need condoms

Question 4

What are the pre-op preparations done before sterilisation

Answer 4

Abstain from UPSI for 3 weeks
Pregnancy test before the procedure

Question 5

What should be done if a patient has sex before sterilisation

Answer 5

UPSI = cancel and reschedule
Protected = continue

Question 6

What is the post-op contraception for sterilisation

Answer 6

Lap: until next menstrual period
Hysteroscopic: for 3 months, discontinue after correct placement is confirmed by x-ray or US

Question 7

What should be done if there is a missed period after sterilisation

Answer 7

Immediate pregnancy test → if +ve → immediate US to check location (as Increased risk of ectopic pregnancy)

Question 8

What are the disadvantages of sterilisation

Answer 8

Failure rate 1/200
Risk of GA
Post-op recovery longer than using LARCs
Increased risk ectopic pregnancy
If want to reverse → not funded by NHS

Question 9

Complications of sterilisation

Answer 9

Generic: bleeding, infection, damage to local structures, procedural failure (1 per 200, 1% peripartum)
Increased risk of future ectopic pregnancy
Anaesthetic complications
VTE damage to other organs (bladder, bowel, vessels)
Risk of conversion to open procedure

Question 10

What is the failure rate for sterilisation

Answer 10

Lap: 1:200
Hysteroscopic: 1:500

Question 11

What is a vasectomy

Answer 11

Interrupting the vas deferens to provide permanent occlusion
Small risk of scrotal haematoma and infection
Post-vasectomy semen analysis should be conducted at 12 weeks to confirm the absence of spermatozoa in the ejaculate
Failure rate 1:2000

Question 12

What questions must you ask someone wanting sterilisation

Answer 12

Have you completed your family
Are you aware that reversal is not available on teh NHS
Are you aware of and understand the risks of the operation
Sensitive questions:
- Would you want more children if you current relationship were to break down
- If one of your children dies, would you want more children